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Ryan, Robert Allen i - # /S1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Allen Ryan Male Date of Death Age If Veteran of U.S.Armed Forces, 02/14/2022 61 Years War or Dates Place of Death Hospital,Institution or niZ City,Town or Village Glens Falls Street Address Glens Falls Hospital a V Manner of Death ©Natural Cause 1=1Accident Homicide 0 Suicide 0 Undetermined Pending Circumstances Investigation E Medical Certifier Name Title Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 112 ❑Burial Date Cemetery,Crematory or Facility Name 02/17/2022 Pine View Crematory 0 Entombment Address aCremation Queensbury,New York EiDonation 0❑ Date Place Removed Removal and/or and/or Held CO Hold Address 0 0. Date Point of t/)�❑Transportation 5by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom t Remains are Shipped,If Other than Above Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2022 Registrar of Vital Statistics IMegan North(ECectronicaCTySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WF -1 1�-� Zkr... Date of Disposition ZI(g IZZ Place of Disposition �,� S• (address) W N CC (section) g(let number) (grave number) SName of Sexton or Person in Charge of Pre i es AS ciA4 it W (pleas print) /��` Signature Title 4(�E�f�{i�t'� DOH-1555(07/18)p 1 of 2 • 7;1565 Public Health Law Sec. 4145(2b) Receipt Human remains of • delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#